Barmparas Galinos, Martin Matthew J, Wiegmann Douglas A, Catchpole Ken R, Gewertz Bruce L, Ley Eric J
Cedars-Sinai Medical Center, Department Of Surgery, Los Angeles, California, USA.
Am Surg. 2016 Nov 1;82(11):1073-1079.
Failure to rescue (FTR), defined as any death after the development of in-hospital complications, is an important quality measure, but the relationship with age after a traumatic injury, has not been well defined. We sought to examine whether older trauma patients are at higher risk for FTR. The National Trauma Databank (NTDB) research datasets 2007 to 2011 were queried for patients ≥16 years who had any reported complication. Those who survived (non-FTR) were compared with those who did not (FTR) using a forward logistic regression model. Overall, 218,986 subjects met inclusion criteria of those, 201,358 (91.2%) survived their complication (non-FTR) and 17,628 (8.8%) died (FTR). A forward logistic regression identified age 65 to 89 years as the strongest predictor of FTR [adjusted odds ratio (AOR) 95% confidence interval (CI): 6.58 (6.11, 7.08), P < 0.001]. Using age group 16 to 45 years as the reference group, the adjusted risk for FTR increased with increasing age in a stepwise fashion [AOR (95 % CI): 1.94 (1.80, 2.09) for age 46 to 65 years, 6.78 (6.19, 7.42) for age 66 to 89 years and 27.58 [21.81, 34.87] for age ≥90 years]. The adjusted risk of FTR also increased in a stepwise fashion with increasing number of complications, reaching AOR (95 per cent CI) of 2.25 (2.07, 2.45), P < 0.001 for ≥4 complications. The risk of failure to rescue increases with age and number of complications. Strategies which track this quality measure to encourage early recognition and treatment of complications in the elderly are necessary.
未能成功救治(FTR)定义为住院并发症出现后的任何死亡情况,这是一项重要的质量指标,但它与创伤性损伤后的年龄之间的关系尚未明确界定。我们试图研究老年创伤患者发生FTR的风险是否更高。我们查询了2007年至2011年国家创伤数据库(NTDB)研究数据集,以获取报告有任何并发症的16岁及以上患者。使用向前逻辑回归模型将存活患者(非FTR)与未存活患者(FTR)进行比较。总体而言,218,986名受试者符合纳入标准,其中201,358名(91.2%)在并发症后存活(非FTR),17,628名(8.8%)死亡(FTR)。向前逻辑回归确定65至89岁为FTR的最强预测因素[调整后的优势比(AOR)95%置信区间(CI):6.58(6.11,7.08),P < 0.001]。以16至45岁年龄组作为参照组,FTR的调整后风险随着年龄的增长而逐步增加[AOR(95%CI):46至65岁为1.94(1.80,2.09),66至89岁为6.78(6.19,7.42),90岁及以上为27.58 [21.81,34.87]]。FTR的调整后风险也随着并发症数量的增加而逐步增加,对于≥4种并发症,AOR(95%CI)达到2.25(2.07,2.45),P < 0.001。未能成功救治的风险随着年龄和并发症数量的增加而增加。追踪这一质量指标以鼓励早期识别和治疗老年人并发症的策略是必要的。